Bethany Baptist Church // Ministries // Vbs

Register for SonSurf Beach Bash VBS by filling out the information below. ONE FORM PER CHILD, please.

Child's First Name

Childn's Last Name

Gender

Male

Female

Date of Birth

Grade going into fall of 2018

Please enter your full address:

Street Address (Please include apartment number, if applicable)

City

State

Zip Code

Primary Phone Number

Other Phone

Email Address

What is the best way to reach you?

Email

Phone

Name of home church, if any (if you do not have a home church, enter "none"):

How did you hear about SonSurf Beach Bash VBS?

If you chose 'other' for the last question, how did you hear about SonSurf Beach Bash VBS?

Parent/Guardian Name(s)

Parent/Guardian Work Phone(s) (only needed if Parent/Guardian will be at work while child is attending VBS)

Emergency Contact Name

Emergency Contact's Phone

Names of adults (18 years or older) who may drop off and/or pick up your child (If no one else is allowed to pick up your child, please enter "none"):

Allergies or Other Medical Conditions (please enter "none" if this is not applicable to this child)

This child may be photographed for non-commercial purposes.

Yes

No

This child has permission to walk to and from Stephens Park WITHOUT an adult.

Yes

No

I certify that the above-named child has my permission to participate in the Bethany Baptist Church SonSurf Beach Bash VBS. In case of injury incurred at VBS, I also grant adult volunteers from Bethany Baptist Church permission to act according to their best judgment in any situation requiring medical attention, and I consent to any medical care deemed advisable by any accredited physician in an approved emergency clinic or hospital.

Yes

No

Today's Date

Event Registration